Yonsei Med J.  2015 Mar;56(2):535-542. 10.3349/ymj.2015.56.2.535.

Selective Spinal Anesthesia Using 1 mg of Bupivacaine with Opioid in Elderly Patients for Transurethral Resection of Prostate

• Kim NY
• Kim SY
• Ju HM
• Kil HK

• KMID: 2070035
• DOI: http://doi.org/10.3349/ymj.2015.56.2.535

Abstract

PURPOSE
This study was to evaluate the characteristics of selective spinal anesthesia using 1 mg of bupivacaine combined with fentanyl or sufentanil in elderly patients undergoing transurethral resection of prostate.
MATERIALS AND METHODS
Fifty-six patients were randomized into two groups. The Fentanyl group received 0.5% hyperbaric bupivacaine 0.2 mL+fentanyl 20 microg+5% dextrose 1.4 mL, and the Sufentanil group received 0.5% hyperbaric bupivacaine 0.2 mL+sufentanil 5 microg+5% dextrose 1.7 mL intrathecally. Intraoperative and postoperative characteristics were evaluated. Patient satisfaction was assessed postoperatively.
RESULTS
Twenty-six patients in each group completed the study. The median peak sensory block level was similar between two groups, but sensory regression time was longer in the Sufentanil group than the Fentanyl group (p=0.017). All patients were able to move themselves to the bed without any aid when they arrived at the admission room. Pain scores were lower in the Sufentanil group than the Fentanyl group at postoperative 6, 12, and 18 hours (p=0.001). Compared to the Fentanyl group, the Sufentanil group required less postoperative analgesia (p=0.023) and the time to the first analgesic request was longer (p=0.025). Twenty-four of 26 patients (92.3%) in each group showed "good" satisfaction level.
CONCLUSION
Selective spinal anesthesia using 1 mg of bupivacaine with fentanyl or sufentanil provided appropriate sensory block level with spared motor function for transurethral resection of the prostate in elderly patients. Intrathecal sufentanil was superior to fentanyl in postoperative analgesic quality.

Keyword

Transurethral resection of prostate; 1 mg bupivacaine; anesthesia; spinal; opioids; aged patients

MeSH Terms

Aged
Aged, 80 and over
Analgesics, Opioid/*administration & dosage
Anesthesia, Spinal/*methods
Anesthetics, Local/*administration & dosage
Bupivacaine/*administration & dosage
Double-Blind Method
Drug Therapy, Combination
Fentanyl/*administration & dosage
Humans
Injections, Spinal
Male
Patient Satisfaction
Postoperative Period
Prospective Studies
Prostate/*surgery
Sufentanil/*administration & dosage
Time Factors
*Transurethral Resection of Prostate
Treatment Outcome
Analgesics, Opioid
Anesthetics, Local
Bupivacaine
Fentanyl
Sufentanil

Figure

• 

  Fig. 1 Consecutive dose of bupivacaine for successful spinal block in fentanyl group and sufentanil group. White circle, successful block; black circle, insufficient block. F, fentanyl; S, sufentanil.

• 

  Fig. 2 CONSORT flow diagram. F, fentanyl; S, sufentanil.

• 

  Fig. 3 Mean arterial pressure and heart rate changes during procedure. F, fentanyl; S, sufentanil; MAP, mean arterial pressure; HR, heart rate.

• 

  Fig. 4 Verbal numerical rating scales (vNRS) for pain during 36 hours after surgery. Box plot with median (solid line), interquartile range (box), and values within 1.5 times the interquartile range (whiskers). Outliers are indicated by circles. *p<0.05 compared with the Group F. F, fentanyl; S, sufentanil.

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